Pam's case sure brought back memories of my own personal case. My middle
daughter was born in 1984, full term. It was a precipitious delivery (she was
out less than an hour after I called the doc from home that I was coming in);
she was blue with apgars of 4/7 at 1/5 minutes. They whisked her off for
observation in the special care nursery (I was the 3-11 charge nurse of the
maternity unit at the time, so probably warranted special treatment).
Altho I worked there, I was in no position to fight the separation under the
circumstances - it was frightening to have a baby with such poor apgars.
Because she did not nurse right away, she also did not pass meconium for over 24
hours. I just "knew" she was going to be jaundiced and sure enough, I was the
one who picked it up at less than 24 hours of age - surprise, surprise!
Now, the policy at that time was to generally treat for a bili of 12-13 with
phototherapy and supplementation, especially if it appeared in less than 24
hours. In my case, a little knowledge turned out to be not such a dangerous
thing. There had started appearing in the literature some new info about
jaundice, and the so-called "breastfeeding jaundice" that we now know to be a
misnomer of "not breastfeeding jaundice". Luckily I had a great pediatrician, who
was also a neonatologist and who knew me and my NICU and OB background, and
was up on current research. He agreed to hold off on treatment or
supplementation at my request, and "allowed" me to just nurse her on my own modified
demand schedule (that is, if she went longer than 3 hours without seeking a
feeding on her own, I woke her and encouraged her, round the clock)...until her
bili went over 20 on day 4. At that point, the doc said that he just could not
put off the treatment any longer and had to recommend phototherapy. That was
the time when home phototherapy was beginning to be pioneered and he agreed
to allow me to be discharged with a home set up. (No bili blankets at that
time - we had to rent the big photo light units). We were pioneers in that
therapy!
Long story short - she, of course, recovered, with bilis returning to normal
after a few days of lots of nursing, and went on to be admitted early
decision to Brown last year! Today, we know so much more, about how bili can be
reabsorbed when the baby doesn't pass meconium; how colostrum works as a natural
laxative to ensure its passing; and we've adjusted our policy on what levels
need to be treated. Isn't progress great! It was cases like this that got me
into the profession of lactation!
Kathy Rubin in NJ
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